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The remainder are cured with chemotherapy at relapse. Patients with elevated serum tumor markers, bulky clinical stage II disease, and all clinical stage III patients require induction chemotherapy. 70% of these patients will achieve CR, and these patients are observed, as the relapse rate is less than 5%. Patients with normalization of serum tumor markers and a persistent retroperitoneal mass routinely require PC RPLND. Outcome is dependent upon pathology. Patients with more complicated disease require individualized therapy, which may involve salvage chemotherapy, surgery, or both.

D. Beck, R. S. Foster, R. Bihrle, L. Cheng, & J. P. Donohue, 2005) (S. D. Beck, R. S. Foster, R. Bihrle, L. Cheng, T. M. 3 Primary RPLND technique The traditional full bilateral suprahilar RPLND involved removal of all lymphatic tissue from the suprahilar areas to the bifurcation of the common iliac arteries, from ureter to contralateral ureter. This was, by intent, a radical procedure, because chemotherapeutic rescue was not available when full bilateral RPLND was initially developed. All sympathetic efferent fibers were sacrificed, and lymphatic tissue was removed en bloc.

Cisplatin-based chemotherapy after retroperitoneal lymph node dissection 42 Germ Cell Tumor in patients with pathological stage II nonseminomatous germ cell tumors. J Surg Oncol, 61(3), 195-198. Cullen, M. , Stenning, S. , Parkinson, M. , Fossa, S. , Kaye, S. , Horwich, A. , . . Jakes, R. (1996). Short-course adjuvant chemotherapy in high-risk stage I nonseminomatous germ cell tumors of the testis: a Medical Research Council report. J Clin Oncol, 14(4), 1106-1113. Divrik, R. , & Zorlu, F. (2006).

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